Provider Demographics
NPI:1134243173
Name:MCLAREN, MARTIN ROOSEVELT (MD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:ROOSEVELT
Last Name:MCLAREN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8521 THORNDEN TER
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-6809
Mailing Address - Country:US
Mailing Address - Phone:301-469-6619
Mailing Address - Fax:301-469-6732
Practice Address - Street 1:10610 RHODE ISLAND AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-2500
Practice Address - Country:US
Practice Address - Phone:301-559-8400
Practice Address - Fax:301-559-9572
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0016372174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB94738Medicare UPIN
DC413862Medicare PIN